HomeMy WebLinkAboutAUTH-06-2022-174370.TIF y4,0Air� CATAWBA COUJ rry '
�7 la Public Health Department Subdivision PINE VALLEY
2..�.m.s, Environmental Health Division PINT 372317118586
1;y� PO Box 389,25 Government Drive,Newton,NC 28658 W Lt7rN 32
Site Address: 975 26TH ST NE,HICKORY NC 28601
Name on Permit: *OAKWOOD HOMES#712
Property Size: Acres 0.45
Directions: McDonald Pkwy,right 12th Av Dr NE(Spencer Rd),right 25th St NE,left 12th Av NE,right 26th St NE just
past 10th Av NE
X; Owner/Authorized Representative Acknowledgement of Permit Receipt
1` iY I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
�(
/" V As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-01-2022-39763,by the following method(s):
Received in Person
---f- Facsimile Transmittal(Return form with signature required)
4 Electronic Image Transmittal/E-mail (Return receipt required)
11 1-1" As the property owner or authorized representative I have reviewed and understand the specific conditions
of the permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC 18A.1900),
and/or Well Construction Standards(15A NCAC 2C.0100), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date:06/22/2022 /
Owner/Authorized Representative Signature
--7z.z—
Date 7 6 -
Documentation of Permit(s)Transmittal
(perm(-transmitted by electronic or other means)
[
Permit transmitted by (name of person sending permit)
Signature _ Date/Time ., 11/ ()7
Method: Fax i Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoa;Please ttake a few momentts tto complette our custtomer service survey att
http://www.sunreymonkey.com/s/ENCusttomerService
hiva'. iv; 11 :5(1144)(ikuiwc+hoAt&• eiwi
`lip iinii 06/22/2022 15:36 t 1